<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<script language="JavaScript">
    function updateAuthor(theForm){
    if(theForm.extensionField_Name){
    if(theForm.extensionField_Name.value!=""){
    theForm.author.value=theForm.extensionField_Name.value;
    theForm.extensionField_Name.name='extensionField_h_Name';
    return(true);}}
    if(theForm.extensionField_Email){
    if(theForm.extensionField_Email.value!=""){
    theForm.author.value=theForm.extensionField_Email.value;
    theForm.extensionField_Email.name='extensionField_h_Email';
    return(true);}}
    return(true);}
</script>
</head>
<body>
<form action="https://141.123.116.10/chatproxy/api/chat/form/100002" method="post" onsubmit="return updateAuthor(this)">
<style type="text/css">span { display: inline-block; width: 120px; }</style>
    <span>Name:</span><input type="text" name="extensionField_Name" /><br/>
    <span>Email:</span><input type="text" name="extensionField_Email" /><br/>
    <span>Details:</span><input type="text" name="extensionField_Details" /><br/>
    <span>Problem:</span>
    <select name="extensionField_ccxqueuetag"><br/>
        <option value="Chat_Csq2">Paychex Accounting Support</option>
    </select><br/>
<input type="submit" value="Submit"/><input type="hidden" name="author" value="Customer"/><br/>
<input type="hidden" name="title" value="ccx chat"/><br/>
<input type="hidden" name="extensionField_h_widgetName123456" value="MainChat"/><br/>
<!-- The following optional, hidden fields are available in order to customize the Customer Chat user interface.
Unlike other extension fields, these are not added to the social contact, and therefore do not display in the Agent Chat user interface.
Replace './img/ciscoLogoColor.png' with the location of your own logo. Replace 'Welcome, please wait while we connect
you with an available customer care representative.' with your own waiting/welcome text. Feel free to replace the remaining values with your own timeout and error messages. -->
<!-- <input type="hidden" name="extensionField_chatLogo" value="./img/ciscoLogoColor.png"><br/>
<input type="hidden" name="extensionField_chatWaiting" value="You may also email at accountingsupport@paychex.com or call (866)246-7500">
<input type="hidden" name="extensionField_chatAgentJoinTimeOut" value="All customer care representatives are busy assisting other clients. Please continue to wait or try again later.">
<input type="hidden" name="extensionField_chatError" value="Sorry, the chat service is currently not available. Please try again later."> -->
</form></body>
</html>